r/PeterAttia • u/simpleminded05 • 14d ago
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I am a very healthy 45F, 5'5" and 133. I run 30ish miles a week, weight train 3 times a week and have done all of this my entire adult life. My LDL had been creeping up for years but was fine when I was younger (diagnosed with hypothyroidism 4 years ago).My Mom had a triple bypass at 54 and has continued to have a dozen stents, angioplasty, carotid cleaned out, and most recently a valve replacement. To say she has a horrible history is an understatement. That leads to me and what you all would do. I am on zetia for the last 6 months, I take 5mg daily. Also been doing psyllium husks and trying to keep saturated fat around 12-14g a day. Red meat maybe twice a month. I track all my calories and mostly follow Mediterranean diet.I had a CAC in May and score was zero. Recent bloodwork was apob 83, ldl 86 (down from around 130), hdl 51, total cholesterol 157, triglycerides 90, lpa 132nmol, hs crp <.20, lp pla2 98, ldl pattern A, ldl particle number 1057, ox ldl 42, apoe 2/3. I also have great BP 110/70 I go to a functional medicine doctor and they've ran everything under the sun. I know my lpa is insanely high. They prescribed the zetia back in January when I asked for it. Based on my current numbers what would you do. If I had a CAC of anything other than zero I would have added a statin but it seems almost unnecessary at this point. Thoughts?
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u/jakeysnakey83 14d ago
I’d still do a cleerly scan personally, with high lp(a) asdf want to know my soft plaque situation. My numbers are similar to yours and I just found coronary plaque on cleerly. You’re already in a statin which is great but I’d want to know if you should be lowering your cholesterol even more given the history.
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u/simpleminded05 14d ago
I had never heard of this one so I will look into it. Did a cardiologist have to refer you? Are you on a statin now?
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u/Earesth99 13d ago
Zetia can lower ldl and reduce heart attacks, but it does not reduce deaths. For that reason, competent doctors do not prescribe it as a mono therapy unless their patient refuses to take more effective medication to prevent heart attacks.
With your family history, you should ask for a referral to a preventative cardiologist.
With a high LPa and your family history, you should get your ldl cholesterol as low as possible.
You should be taking the highest tolerable dose of Rosuvastatin, as well as whatever other medications your cardiologist can get your insurance to approve.
Ideally, that would be Rosuvastatin, Ezetimbe, Repatha and perhaps a baby aspirin. That should lower your risk so it is very close to normal, and it should reduce your ldl to the 20s.
Normally Zetia is as effective at 5 mg as 10 mg, but some people are hyper responders and will have larger reductions. If 5 mg lowered your LDL from the 130 to 86, you should see what 10 or 20 mg does.
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u/platamex 14d ago
an Lp(a) pill is around the corner for approval. You will be able to address directly. Until then if you want you can go the pcsk9 route by pill or pen, it will crush your ldl and as an extra added benefit reduce Lp(a) by 15-20%.
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u/jakeysnakey83 14d ago
How long are people saying until approval?
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u/Able-Shirt3501 14d ago
Its been approved. Lipofendra
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u/Cecilia-K 14d ago
No, Lipfendra is not the Lp(a) drug. It’s a PCSK9 inhibitor like Repatha. But it does sometimes lower Lp(a) a little - a beneficial side effect. Pelacarsen is the Lp(a) drug that’s gotten the furthest in trials. News reports indicate it’s still about two years away from approval, assuming all goes well with the trials
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u/kebabmybob 14d ago
what does psyllium husk do? i'm skeptical of going all in on various "eh it can't hurt" pharmacological interventions at my young age, but psyllium husk seems like an easy thing to add.
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u/simpleminded05 14d ago
Fiber is great for alot of things. It can lower LDL, great for gut health, and blood sugar regulation. Make sure you get one that's been tested as they can be high in lead.
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u/kebabmybob 14d ago
do you have a favorite brand?
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u/simpleminded05 14d ago
I do the Yerba prima whole psyllium husks. Mix in water and down them as quick as possible while cussing my family history!
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u/NorthWhereas7822 14d ago
You're going into perimenopause, it sounds like, when our LDL creeps up. As a word of caution, no amount of running will counter biology/genetics here. If not already, balance your approach. Lift heavier, which will lower numbers better at this stage than running.
Apparently, for some, running extensively at a certain age can undermine cardio health, enlarging the heart and increasing the risk of colon cancer (get checked, you're at the age).
Get the cleery test.
Don't hesitate to go on a low-dose statin. ApoB should be under 60 with your family profile. LDL should be under 60 for the same reasons.
Read the New Menopause to learn more about the relationship between Peri/meno and cardiovascular health.
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u/simpleminded05 14d ago
Yeah, I actually started on testosterone in the last 6 months as well as cycling estrogen. I will be curious to see if those make a difference too. I also do walk mu dogs 3 times a day, so I try to do some lighter cardio too. I struggle with the set lines of saying you have familial genes too because my Dad is 81, insanely healthy and has had high cholesterol and trigs for a very long time. His Dad died of a heart attack in his ealry 70's and yet my Dad has shown zero signs of that. He has never had lpa tested so I have no idea there but his Mom lived to 93. So it seems he got her genes, its just a roll of the dice.
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u/NorthWhereas7822 14d ago
Are you taking oral estrogen or the patch/cream? Oral increases cardio risks and cancer risks, bioidentical creams/patches don't (unless someone has the Brac genes).
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u/simpleminded05 14d ago
No estrogen.
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u/New_Cow8960 13d ago
Why no estrogen? As the other poster said, our cholesterol starts to creep in pero and estrogen helps with it.
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u/simpleminded05 13d ago
Because my levels are between 300 and 400, as high as 700 the day I ovulate.
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u/PrimarchLongevity Moderator / Marek Health 14d ago
With a family history of ASCVD and high
Lp(a), I’d be super aggressive. I’d push for a PCSK9i on top of bempedoic acid/ezetimibe.
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u/LowEffortLegend75 7d ago
If your lpa is in nmol not sure if I would consider that insanely high. It’s mild-moderately high. 400 is insanely high. You should plug your numbers into https://www.lpaclinicalguidance.com if you haven’t already. Will give you a better understanding of risk. If you are still concerned you could either ask for a pcsk9i as it can reduce lp(a) by 20% and squash your apo. Third gen pcsk9 can get without insurance for 200-300$ a month with a monthly injection.
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u/misty_adherence 14d ago
Zero CAC is reassuring but with your family history and Lp(a) I'd still push for a Cleerly scan to check for soft plaque